Justification for Rhinoseptoplasty in Children - Our 10 Years Overview

Abstract

Background: Nasal septal surgery and rhinoplasty are controversial in children. Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 16 to 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region.

Aim: The aim of this paper was to present the results of rhinoplasty in children in order to restore the anatomy and function or to promote normal development and outgrowth of the nose.

Material and methods: Ninety seven children aged 6-14, with severe nose deformities and breathing problems through the nose, were admitted for septo/rhinoplasty at the University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of Macedonia. At our Clinic, they have been observed and photographed (with parent permission) in the period of 10 years (2006-2016). The most frequent cause of these deformities was the nasal trauma in early childhood which was ignored or untreated. All of them rhino/septoplasty were indicated in accordance with the above-mentioned recommendations for rhino/septoplasty in early childhood and in adolescents.

Results: In 51 children and adolescents septoplasty were prepared. Mostly there was a group of younger children age from 6-10 (68%) and adolescents (32%). In the other 31 children and adolescents, septorhinoplasty was prepared. Mostly there were children older than 12 years old and adolescents (70%). Only 30% were younger than 12 years, of course with severe nasal breathing problems, nasal septal deformities and deformities of the nasal pyramid.

Conclusion: The growth centres of the nose have to be avoided if possible; long-term nasal issues will theoretically be minimised. If the surgeon replaces it, the cartilage of the nose becomes straighter but still intact.

Keywords: indications; midfacial development; nasal growth; septo/rhinoplasty in children; surgical procedures.

Figure 1

Facial profile of a child (7 years old) and her mother (44 years old). The differences in the proportions and size of the nose, facial and brain scull are obvious. The infant’s face shows smaller vertical dimensions, less frontal projection of the nose and a larger nasolabial angle (with the permission of parents)

Figure 2

Making photographic documentation is important to define qualifications as normal or abnormal, which are in essence subjective (with the permission of parents)

Figure 3

Saddle nose (rhinolordosis) due to untreated septal hematoma after the nasal trauma in early childhood) (with the permission of parents)

Figure 4

Classification of the deviations of the nasal septum in children by groups

Figure 5

Eight years old boy with DSN. a) Pre operative results; b) 6 months after surgery; c) Two years after surgery (with the permission of parents)

Figure 6

Twelve years old girl. a) Pre operative results; b) 1 year after surgery (with the permission of parents)

Figure 7

Eleven years old girl with DSN. Rhinokyphosis after nasal trauma in early childhood. a) Pre operative results; b) after surgery (with the permission of parents)

Figure 8

Fourteen years girl. Rhinoscoliosis and rhinolordosis (after nasal trauma). Graft (from auricula) augmentation on the nasal dorsum (with the permission of parents)